The total Wirral population is 324,336 (Office for National Statistics (ONS) mid-2020 data). The 65+ population is 71,289. ONS projections indicate that the population is estimated to increase by 4.1% to 336,300 between 2018 and 2043. This hides large variations when looking at specific age groups, with the population of children and young people (0-14) decreasing by 8.2%, while the population of older people (90+) is projected to increase by 96.3%.
The following statistical items are some of those that are higher for Wirral than the England averages (data source: wirral.communityinsight.org):
|
|
England |
Wirral LA |
|
65+ population % |
18.5% |
22.0% |
|
Dependency ratio |
0.60 |
0.68 |
|
Pensioner households % |
20.7% |
23.5% |
|
Pensioner one person households % |
59.6% |
62.3% |
|
Pensioners without access to private transport % |
40.8% |
41.8% |
|
Pension credit claimants % |
11.3% |
12.8% |
|
Benefits claimants % (workless) |
8.6% |
11.0% |
|
Benefits claimants % (incapacity) |
4.1% |
6.8% |
|
Housing affordability gap £ |
-£39,328 |
-£50,112 |
|
Disability claimants % for living allowance |
2.0% |
3.1% |
|
Disability claimants % personal independence payments |
7.2% |
12.5% |
|
Disability claimants % attendance allowance |
11.5% |
13.2% |
|
Universal credit households % for carer entitlement |
1.7% |
2.4% |
|
People providing unpaid care % |
10.2% |
12.6% |
|
Mental health related benefits % |
2.0% |
3.4% |
|
People living in health deprivation hotspots % |
19.6% |
51.9% |
|
Households living in fuel poverty % |
13.2% |
14.4% |
|
Personal debt per head £ |
£575.80 |
£618.10 |
The Wirral Plan
The Wirral Plan 2021-2026 defines the key priorities for the Local Authority over the coming years – outlining those tasks which the council will focus on to ensure the people of Wirral receive the services they need and want, based on what people said matters most to them. View the Wirral Plan.
Further information
Wirral Council is a member of the Liverpool City Region Combined Authority and works collectively across Cheshire and Merseyside ICB region.
On completion of the Fair Cost of Care exercise the council did publish as required the Annex B documents for both Residential and Nursing care and also for Domiciliary Care.
View the documents:
- Annex B - Wirral Fair Cost of Care Exercise: Care Home (Residential)
- Annex B - Fair Cost of Care Exercise: Domiciliary Care
On completion of the Fair Cost of Care exercise, whilst the council felt that it had received good representation and submission of data from the residential and nursing care home market, it was not confident that the outcome of the exercise reflected an achievable position for the council or that the end of the exercise rates published I annex B were representative had the entire care home market participated.
Section 1: Assessment of the current sustainability of local care markets
a) Assessment of current sustainability of the 65+ care home market
As at the start of March 2023, there are 71 care homes for people 65+ in Wirral, with a maximum capacity of 2,766. There are 456 vacancies (16.5%), of which 296 are admittable vacancies (10.7%). The table below illustrates the breakdown per care type:
| All vacancies | Maximum Capacity | Vacancies Number | (Total) % | Vacancies Number | (Admittable) % |
|---|---|---|---|---|---|
| Dementia Nursing | 446 | 81 | 18.16% | 58 | 13% |
| Dementia Residential | 680 | 75 | 11.03% | 61 | 8.87% |
| General Nursing | 820 | 118 | 14.39% | 94 | 11.46% |
| General Residential | 820 | 182 | 22.20% | 83 | 10.12% |
| Total | 2,766 | 456 | 16.49% | 296 | 10.70% |
The average occupancy level for all homes is 88%. Three homes have occupancy levels below 50%. 68 homes have occupancy levels above 80%.
There is sufficiency of supply for standard residential and nursing care, however there is a shortage of dementia provision (residential and nursing EMI); there is a risk that Wirral could be oversubscribed by winter 2023, and commissioners are working with Integrated Care Board colleagues to improve capacity in Residential and Nursing EMI categories for complex cases. The ongoing development of Older Peoples extra care units, growth of the domiciliary care market, and the strategic direction to provide added support for independence through new technologies, is intended to mitigate this risk.
In June 2022, the council did a voluntary review with its care home sector. The outcome of the exercise showed there is a good mix of large and small providers. There were three homes that are 100% reliant on Wirral funded clients with a further nine homes that have over 80% of their clients Wirral funded. Seven homes had less than 35% of their clients Wirral funded. The Nursing sector is the most reliant on Wirral funded clients at 68%, while the residential sector is the least reliant at 52%. One home has been closed and one has been sold since June 2022, but this has not significantly affected the market.
In general, areas in the east of the borough (e.g. Birkenhead Central) are more deprived than in the west (e.g. Lower Heswall). This is reflected in care home placements – most self-funder placements are in the west, most council-funded placements are in the east.
There are currently eight purpose-built extra care schemes funded by the council that provide 329 general tenancies and ten specialist dementia tenancies. In addition, there are six specialist LD extra care schemes with 85 units now active and another 21 units due in 2022.
New extra care schemes are continuing to be developed in line with the Wirral Plan aims for specialist housing. By the end of 2023, we aim to provide an additional 156 units. Extra care will be increasingly used as an alternative to residential care. We are working with developers to increase the provision for older people who have additional needs than ‘standard residential’, and to develop this type of accommodation for adults with disabilities. The Care Quality Commission (CQC) ratings are a key indicator of quality, alongside internal quality monitoring processes (PAMMS). As at the start of March 2023, CQC ratings for all care homes are as follows:
| CQC rating categories | Outstanding | Good | Requires Improvement | Inadequate |
|---|---|---|---|---|
| Number of care homes | 0 (0%) | 71 (61.2%) | 44 (37.9%) | 2 (0.9%) |
A small number of homes have been ‘Requires Improvement’ for some time. The council has undertaken a review of its approach for commissioning, contracts and quality and a new policy has been agreed via governance routes to manage and improve the community care sector in Wirral.
Wirral Council uses the Provider Assessment and Market Management Solution (PAMMS) tool to help assess the quality of care being delivered by providers of Adult Social Care services. It is a web-based system that providers gain access to via a portal once an assessment has been completed by a quality improvement practitioner. Intelligence from the PAMMs will be used to inform the strategic review of the care home market for future delivery.
PAMMS supports a consistent approach to monitoring commissioned providers. It:
- enables providers and quality improvement teams to work together to achieve better outcomes for residents of Wirral
- gives providers the opportunity to sense-check their internal quality audits against Wirral Council’s independent audit
- enables an objective quality audit to be undertaken that supports providers in establishing what is working well and what areas may require improvement
- helps to identify where the council should provide additional support, signposting, or referral to expert teams, for example, infection control, medicine management
- leads to improved Care Quality Commission ratings for providers
The council will publish CQC ratings on its website from April 2023 including where services are suspended from providing a service due to quality or contractual concerns.
The council completed a strategic review of the borough’s care homes in Spring 2022. A key objective of this exercise was to identify vulnerability in the sector and identify which homes might be at risk of failure or require support, and to provide underpinning intelligence prior to the commencement of the Market sustainability: fair cost of care exercise in Summer 2022. The outcome of the exercise confirmed which services are reliant in the main on council funding, an overview of the funding streams allocated to the market, and a confirmation of oversupply in the residential care home sector, which will increase when the council opens 156 new Extra care apartments during 2023. The exercise also highlighted an undersupply in residential and nursing EMI provision, which the council is addressing with discussions with providers to increase supply in that field in 2023 prior to Winter.
Since May 2020, Wirral Council has encouraged all care providers to pay staff the Real Living Wage (RLW) and receive an enhanced fee rate. This initiative has helped to support the market during COVID-19 and recognises the valuable work undertaken during the pandemic by the social care workforce. This initiative has continued and since its introduction has seen the percentage of Wirral funded people in receipt of a residential and nursing service to 85%, and for all care sectors as follows:
| Care Type | % |
|---|---|
| Residential and Nursing | 85 |
| Domiciliary Care | 99 |
| Supported Living | 91 |
In March 2023, the council agreed to approve funds to continue to support all community care market providers to take up the RLW and an enhanced rate remains in place.
The table below illustrates the rates for Residential and nursing services with both council and market sustainability funds included:
| Care Type | Fee Type | Unit | 2022/2023 | 2023/2024 | Monetary Increase | % Fee Rate increase |
|---|---|---|---|---|---|---|
| Residential Care - Long Term | RLW | weekly | £550 | £637 | £87 | 15.8% |
| Standard | weekly | £532 | £618 | £86 | 16.2% | |
| Residential EMI Care - Long Term | RLW | weekly | £616 | £710 | £94 | 15.3% |
| Standard | weekly | £595 | £687 | £92 | 15.5% | |
| Nursing Care - Long Term | RLW | weekly | £596 | £701 | £105 | 17.6% |
| Standard | weekly | £571 | £671 | £100 | 17.5% | |
| Nursing EMI Care - Long Term | RLW | weekly | £633 | £743 | £110 | 17.4% |
| Standard | weekly | £607 | £710 | £103 | 17.0% |
The total funding to support all 2023-24 rates has been allocated by Wirral Council as follows:
| £10.05m | Fee Uplift Growth |
| £4.22m | Market Sustainability Funding |
| £0.52m | Growth |
| £14.79m | Total |
The council has focussed its market sustainability funding on residential and nursing care for older people and also to increase rates for domiciliary care to pay front line staff a wage above the Real Living Wage at £12 per hour. This allocation of funds has supported recruitment and retention in the domiciliary care market and will support to maintain and grow the market moving forward to meet local demand. The council has taken into account cost of living challenges when allocating financial resources.
Assessment of current sustainability of the 18+ domiciliary care market
There are 25 domiciliary care providers in Wirral. There is currently insufficient supply of domiciliary care to meet local demand. South and West Wirral are the most challenged areas for delivery.
Most domiciliary care providers in Wirral are small, local organisations. Wirral Council recognises the challenges around recruitment and retention for domiciliary care staff and has been working with providers to attract people to the sector and to retain existing staff.
Workforce Recruitment and Retention funds have been used to introduce a range of support initiatives. A ‘Care Friends’ app has been launched. E-bikes are being made available to help with transport. The Skills for Care ‘Finders Keepers’ approach to finding and keeping the right people with the right values is being used in order to promote value-based recruitment. Recruitment events are being held in local areas in partnership with the university and Local NHS providers.
Since May 2020, Wirral Council has encouraged all care providers to pay staff the Real Living Wage (RLW) and receive an enhanced fee rate. This initiative has helped to support the market during COVID-19 and recognises the valuable work undertaken during the pandemic by the social care workforce.
In March 2023, Wirral Council agreed to approve funds to continue to support all community care market providers to take up the RLW and an enhanced rate remains in place. The table below illustrates the rates for Domiciliary Care:
| Care Type | Fee Type | Unit | 2022/2023 | 2023/2024 | Monetary Increase | % Increase |
|---|---|---|---|---|---|---|
| Domiciliary Care | RLW | hourly | £18.47 | £21.72 | £3.25 | 17.6% |
| Standard | hourly | £17.61 | £19.02 | £1.41 | 8% |
The Care Quality Commission (CQC) ratings are a key indicator of quality. The chart below is an extract from the ADASS ratings monthly report, January 2023, which uses CQC data to illustrate the proportion of Community Based Providers rated Good or Outstanding per LA:
| Liverpool City Region | % of Community Providers rated good or outstanding with CQC |
|---|---|
| Halton | 88.9% |
| Knowsley | 91.7% |
| Liverpool | 87.8% |
| Sefton | 95.3% |
| St Helens | 92.1% |
| Wirral | 88.1% |
From August 2022, the council utilised Fair Cost of Care and Market sustainability fund to support the domiciliary care sector with an increased rate to front line staff of £11 per hour, up to 31st March 2023. In March 2023 the council agreed to use the Fair Cost of Care and Market sustainability fund to raise pay for front line domiciliary care staff to £12 per hour to both maintain and grow the market.
This has resulted in increased staff numbers within the market and has increased domiciliary pick up on cases as follows:
Total Hours Accepted:
| Month | Change of Provider | Community | HCA | Hospice | Hospital | Mobile Nights | Physical Disability | T2A |
|---|---|---|---|---|---|---|---|---|
| Aug-22 | 96 | 809 | 18 | 1203 | 86 | 168 | ||
| Sep-22 | 91 | 1034 | 977 | 103 | 208 | |||
| Oct-22 | 42 | 1117 | 74 | 19 | 953 | 96 | 273 | |
| Nov-22 | 56 | 971 | 88 | 1382 | 96 | 0 | 186 | |
| Dec-22 | 45 | 558 | 74 | 60 | 1137 | 116 | 0 | 247 |
| Jan-23 | 217 | 875 | 128 | 60 | 1004 | 82 | 0 | 116 |
Total Number of Packages:
| Month | Change of Provider | Community | HCA | Hospice | Hospital | Mobile Nights | Physical Disability | T2A |
|---|---|---|---|---|---|---|---|---|
| Aug-22 | 6 | 89 | 1 | 77 | 3 | 11 | ||
| Sep-22 | 6 | 105 | 75 | 5 | 11 | |||
| Oct-22 | 1 | 117 | 9 | 2 | 94 | 3 | 10 | |
| Nov-22 | 5 | 97 | 14 | 96 | 3 | 0 | 11 | |
| Dec-22 | 2 | 62 | 10 | 2 | 97 | 3 | 0 | 10 |
| Jan-23 | 8 | 112 | 21 | 4 | 96 | 4 | 0 | 9 |
Section 2: Assessment of the impact of future market changes (including funding reform) over the next 1-3 years, for each of the service markets
Market Relationships
Wirral has invested time and resources in to building good working relationships with our provider market. We hold regular forum meetings on a monthly basis as a minimum with our community care market which serve to both share information, offer guidance and support and inform in respect of future commissioning requirements. Engagement events also serve to jointly shape and coproduce local services. We seek the market views on initiatives and listen and act on the market feedback to us. Relationship management is an important part of our commissioning offer, with commissioned providers have named contacts within the council for contract and quality improvement purposes. We are able to evidence proactive working with our market, with some excellent examples of hospital and intermediate care discharge initiatives, and incentives to the domiciliary care market to support those.
Care Act Implementation
The government will introduce a new cap on the amount anyone in England will need to spend on their personal care over their lifetime, alongside changes to means test thresholds:
- cap on care costs – residents will pay no more than £86,000 against care charges
- means test thresholds – an increase in the lower capital limit to £20,000 and an increase in the upper capital limit to £100,000
This will result in considerable loss of income for Wirral, starting in 2025/26 and rising in following years as the cap on care cost is reached. The delay in the implementation allows Wirral proactive planning time, with modelling and market shaping opportunities, which will be managed via our established project workstream dedicated to this area of work.
Implementation of Charging Reform in Wirral will increase demand for care act assessments and financial assessments as current self-funders approach the Local Authority to commission care on their behalf. This will lead to a requirement to increase Social Worker/Assessment staff needed. The council has had its Social Work service outsourced and will return one of its social work contracts to the council in July 2023.
Analysis by Newton Europe on Wirral's current workforce suggests an additional 17 Social Work staff processing 670 additional care act assessments and four Financial Assessment workers covering 570 additional financial assessments per year will be required. Additional systems requirements will be needed to record and maintain care accounts. This will be kept under review as part of the Wirral response to the reform’s introduction. A project group is established to manage through the required changes in preparation for implementation of the charging reforms.
Current estimations of self-funders in the care home market is up to 50% of the current care home cohort.
Wirral Financial Scenario
Wirral has faced significant financial challenges in recent years and uncertainty in relation to future funding and affordability is an issue. Over the next four years, the council aims to deliver the Wirral Plan 2026, which includes reducing costs of council services by only providing those services that generate the most beneficial outcomes; generating income wherever possible to bridge the resources gap; and managing increasing demand whilst delivering services that are vital to residents as efficiently as possible.
In February 2022, the council approved a budget for 2022/23 together with an indicative budget for the following four years. However, more recently the council has updated its 2023/24 budget position and MTFP, highlighting changes in financial assumptions and the approach to budget setting. These changes have arisen as a result of the national picture of high inflation and rising costs which are impacting on the budget gap, causing it to increase significantly for 2023/24. It should be noted that these financial challenges are facing the whole country and Wirral, like most other council’s, is now facing a significantly worsened assumed budget gap for 2023/24, which currently stands at £49m.
Working with Providers
An annual Rates and Fees Engagement process took place during 2022/2023 between December 2022 and January 2023 (separate to the Fair Cost of Care exercise) and feed into the council’s Medium Term Financial Strategy (MTFS). The council allocated funds, and proposed rates to the community care market, will await the announcement of available funds from the Fair Cost of Care initiative. These will be included in the rates and fees engagement process, with a total allocation of funds for 2023/24 as follows:
| £10.05m | Fee Uplift Growth |
| £4.22m | Market Sustainability Funding |
| £0.52m | Growth |
| £14.79m | Total |
Our Neighbourhood Working Model and ‘Good Lives’ is about working with social work service and commissioned social work providers, the local community care market and third sector to ensure the best possible outcomes for the population across Wirral. Key principles are:
- engaging stakeholders across all sectors in decision-making
- moving to place-based and strength-based commissioning
- co-production with individuals and the wider citizenship
- critical-thinking and problem-solving with people with lived experience
- local flexibility
- long-term commitment from all partners
Section 3: Plans for each market to address the sustainability issues identified, including how fair cost of care funding will be used to address these issues over the next 1 to 3 years
- 65+ care homes market
- 18+ domiciliary care market
In respect of any future distribution of Fair Cost of Care Funds, we will aim to use these to:
- prioritise people being cared for at home and to support flow from acute hospital settings, as part of our health and care system developments for “home first” and reablement, with a key focus on domiciliary care sector. Our current domiciliary care pay rate initiative shows promise in terms of market response and case uptake and we will keep this under review as part of our hospital discharge and seasonal winter planning arrangements
- enhance offers to the Care Home market for sectors which are anticipated to be under supplied e.g. dementia care for both residential and nursing
- consider a quality incentive payment for well performing homes, as part of the CQC and PAMMs assessment arrangements
Priorities for adults’ care services over the next three years:
- to co-produce a new model of care, for the Care and Support at Home Service, as part of a whole system rehabilitation and reablement model
- to grow the use of new technology and equipment to support independence
- to continue to roll-out new commissioning intentions, including expanding the use of social value
New models of co-operation with providers to deliver Trusted Assessment will strengthen local responses and streamline processes so that people experience a better, co-ordinated response. We aim to increase the numbers of people accessing services online and being able to source local offers for themselves via the Wirral Info Bank (https://www.wirralinfobank.co.uk/). We will further develop outcomes-based commissioning and collate and report data and intelligence from providers to evidence improving outcomes.
Working collaboratively with Liverpool City Region Commissioners, we will use a Flexible Purchasing Framework, supporting providers to access work across the region, and enabling greater choice for people who need services. We will work with Cheshire and Merseyside partners on a Digital Transformation Programme. We will work with the local community care market to improve the quality of services provided and improvement in Care Quality Commission ratings.
Key activities summary:
- care and support at home – to always take people home first from acute settings where possible; to help people to stay at home and not admit to residential or nursing settings including hospitals; to have a robust domiciliary care market which is flexible and responsive
- support people to help themselves – to have a comprehensive reablement offer with partners throughout the Health and Care system; to implement technology solutions that support care placement setting, reduce dependency, and align with workforce strategies
- promote independence – support people to access universal services; increase confidence; provide a range of day services for all ages and client groups; support people with disabilities into employment; support people to use technology and equipment to be more independent
- extra Care, Supported Living, Respite Care – to continue to develop and promote extra care accommodation; to update the supported living model and commissioned respite service, to pilot the introduction of Trusted Assessment; to review the model of night-time support; to promote the use of Direct Payments; to promote the use of new equipment
- Residential and Nursing care – to put the Care Home Development Plan into action; to support the care market with new technologies, equipment, and tools; to increase choice and control for people; to reduce numbers of long-term beds; to improve the quality of care
- advocacy, mental health – to commission services for targeted advocacy; to develop self- advocacy and peer advocacy, to introduce remote monitoring and new technology with Cheshire and Merseyside; to promote best practice, collaboration, and opportunities
- supporting carers, Shared Lives – to increase the number of carers receiving an assessment; to implement direct payments for carers; to update the strategy and support services for carers; to establish a Shared Lives service offer and framework
- further activities. Support people with sensory impairments to be independent and access community support. Continue work with the new Healthwatch Wirral and Independent Health Complaints Service. Improve translation services. Increase the numbers of people using pre- paid cards
Wirral Council vision
The Wirral Plan 2021-26 was approved by council on 6 September 2021. It is built around five strategic priorities:
- a sustainable environment
- bright futures for children and young people
- helping businesses to create jobs and opportunities for all
- vibrant communities where residents feel safe and are proud to live
- supporting happy, healthy lives with the right care at the right time
These priorities sit alongside the borough’s Healthy Wirral Plan which includes the following aims:
- GPs, community nurses and social workers accessible seven days a week
- more services that are currently delivered in hospitals to be delivered in the community
- health and social care professionals working together (one assessment, one plan, one co-ordinator)
- specialist care for those that need it
- support for people to look after their own health and care
The self-care workstream builds on Wirral’s Healthier Lives Pledge to support people to take control of their wellbeing. The Integrated Care Board and commissioning and provider partners in the Wirral Place co-operate as one to help people to help themselves and directly support only those with the greatest need. Our care market and voluntary sector are a key part of this approach.